| NPI | 1396177903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI 2552) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 29363) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2014-11-04 |